patient care today - NewYork

NewYork-Presbyterian
News and Information for the Alumni of NewYork-Presbyterian Hospital Summer 2010
PATIENT CARE TODAY
HIGH TECH, HIGH TOUCH
Top Ranked Hospital in New York.
Ten Years Running.
PATIENT CARE TODAY
HIGH TECH, HIGH TOUCH
On the cover: John Karwowski, MD (far right), with first-year fellow Francesco Aiello, MD (center), and Michael Wright, RN (far left), perform an
endovascular procedure in one of the Hospital’s new high-tech ORs. According to Dr. Karwowski, the Artis zeego® OR system can image the entire body
with technologies such as fluoroscopy-based intravascular ultrasound very easily and stay out of the physicians’ way at the same time. “If you’ve ever
been in the old OR, it’s like Jetsons versus the Flintstones,” says Dr. Karwowski.
HIGH TECH
At NewYork-Presbyterian Hospital, the union of industrial
robotics with diagnostic and interventional applications is
profoundly altering the delivery of patient care. Thanks to
the availability of the Artis zeego® system at both campuses,
physicians are able to provide patients with more effective
diagnosis and treatment in a shorter amount of time.
At NewYork-Presbyterian/Weill Cornell Medical
Center, John K. Karwowski, MD, a vascular surgeon and
expert in the diagnosis and treatment of the full spectrum
of vascular disease with specialized expertise in minimally
invasive interventions, was involved from the beginning of
the new OR systems, helping to customize the zeego® for
the needs of the Hospital’s vascular surgeons to make sure
that it suited the types of procedures they were planning to
do. “Because of the system’s flexibility, it opens up new
possibilities for surgical and endovascular approaches,”
says Dr. Karwowski. “We can do things much more easily
than we could before and it enables us to be more creative
in terms of devising solutions for patients. If a patient needs
a customized procedure, the zeego® room allows us to expand our repertoire of solutions to treat arterial and venous
problems from the head to the toes.”
Whether suspended from the ceiling or retracted to its
minimal footprint, zeego® provides maximum utility in the
least possible space. The maneuverability of the robotic
multi-axis system, along with the quality of the high resolution, large screen images, provides an incomparable degree
of targeted visualization. Large volume 3-D imaging with
coverage equivalent to conventional CT exposes patients
and OR personnel to less radiation.
The Artis zeego® system also makes it possible to have
multiple information systems integrated in the same room.
Pre-intervention screenings and scans can be combined with
real-time patient data. The entire team has all the available
information for enhanced decision-making right there in the
OR. And zeego® brings an unparalleled level of precision
and thoroughness to diagnosis and intervention. “Everyone
is aware of the progress of the patient,” says Beryl Muniz,
RN, Vice President, Perioperative Services at NewYorkPresbyterian/Weill Cornell. “That supports greater safety,
greater teamwork, and ultimately better care for the patients.”
Ms. Muniz also noted that as a result of this technology,
nurses are acquiring interventional knowledge and skill
that ordinarily would not have been within their particular
areas of expertise.
Minimally Invasive New Technologies Program
In 2007, NewYork-Presbyterian and Weill Cornell Medical
College established the Minimally Invasive New Technologies
(MINT) program to tap into the expertise and experience of
clinicians as innovators in the development of new devices,
tools, and procedures to make surgery less invasive. MINT
is led by Jeffrey W. Milsom, MD, Chief of Colon and Rectal
Surgery, and Howard A. Riina, MD, Co-Director of Interventional Neuroradiology.
Engineering and Business Development are provided by
J. Frederick Cornhill, PhD, Administrative Director, who has
more than 30 years experience in the medical device development field and founding Director of the Institute for Biomedical Engineering at Oxford University, and Christopher Dillon,
Director of Business Development and Operations. Also part
of the MINT leadership team is Emme Deland, Senior Vice
President of Strategy at NewYork-Presbyterian. Until her recent retirement, Barbara Pifel, Associate Dean for Sponsored
Programs at Weill Cornell, championed this unique relationship between the Hospital and the Medical College.
A donor-funded program, MINT has several projects in
the pipeline, including a new catheter-based technology to
treat complex cerebral aneurysms; a new endoscopic device
platform that vastly improves the effectiveness of endoscopes as diagnostic and surgical tools; and an endovascular
device platform that enables treatment of disease and trauma
in veins and arteries without open surgery.
“Each project begins with identifying an unmet clinical
need and the patient impact of meeting that need. The team
then delves into clinical, engineering, and business strategy
brainstorming sessions focused on the ultimate goal of bringing game-changing procedures and devices to patients,” says
Mr. Dillon. “Clinical development, product development, intellectual property development, and business development all
move ahead in lockstep. We want to make sure that when we
launch a product it has the best chance of success – solving significant unmet clinical needs for the greatest number patients.”
Applying IT to DVT Prevention
Deep vein thrombosis (DVT) with pulmonary embolism is a
leading cause of preventable in-hospital deaths in the country. It is a national patient safety goal and quality indicator
being looked at by accreditation bureaus and payors alike.
At NewYork-Presbyterian, prevention of DVT through risk
assessment is built into the Hospital’s computer-based order
entry system, Eclypsis, supporting the importance of DVT
prevention as a routine part of delivering care to patients.
“In terms of DVT, perhaps what is most exciting is not
necessarily leaps and bounds in treatment, but rather the increased enthusiasm for detecting and preventing it,” says
Nicholas J. Morrissey, MD, Director of Clinical Trials, Division
of Vascular Surgery, NewYork-Presbyterian/Columbia University Medical Center. “If you look at people who are at risk
for DVT worldwide, half of those who should be on prophylaxis are not, and of those who are on a protocol, a significant
percentage are not on adequate levels of prophylaxis.”
Over the past two years, Dr. Morrissey and his colleagues
have developed a process tied into Eclypsis so that every
patient who is admitted will have DVT risk and prevention
addressed. “We want to make sure every doctor has the
concept of DVT prevention in their mind when they admit a
patient. We also have a link on the computer order entry system to the American College of Chest Physicians Guidelines
on recommendations based on risk level. We provide a limitless electronic and user friendly resource for people to address
DVT, and we have improved the ability to collect data that
defines the incidence of this complication.” A comparison of
the incidence of DVT (calculated per 1,000 patient hours)
before and after the implementation of the risk assessment
protocol is now underway.
HIGH TOUCH
“Our effort to improve the patient experience is a robust,
data-driven program focused on best practices,” says Jaclyn
A. Mucaria, Senior Vice President, Ambulatory Care and
Patient Centered Services. “‘High touch’ care is not something that should happen sporadically. We developed a set
of performance standards that addresses how we interact
with patients, how we enter rooms, explain things, and respond to complaints because those are high touch moments
that should be managed thoughtfully and fully by every
member of the staff, including residents and fellows. This
translates into better quality of care and improved safety and
satisfaction for all of our patients and families. It’s the inconsistency of the touch points which is our biggest challenge.”
Each year, for the past several years, NewYorkPresbyterian has improved patient satisfaction across
the Hospital as measured by the Press Ganey survey tool.
Maria Perez, RN, received the Hospital’s Clinical Excellence Award
recognizing her commitment to improving the patient experience.
In 2009, the Hospital’s goal was to improve its patient
satisfaction rating by 1.2 points to reach 83.6 for the year.
By the last quarter of that year, it achieved an overall patient
satisfaction score of 84.0. Since then, the Hospital has made
significant progress toward its 2010 goal of 85.5.
“Feedback from the Press Ganey survey clearly indicates
that the areas our patients felt we could improve were associated with teamwork, communication, and understanding
their concerns, needs, and anxieties,” says Rick Evans, Vice
President, Support Services and Patient Centered Care. “We
identified those moments of truth in a patient experience that
make a difference and provide training to staff so how we
interact with patients is consistent throughout the Hospital.”
“Generally, people are pleased with the care that they
receive from their physician,” adds Ms. Mucaria. “But there
are also areas of opportunity where doctors, too, can enhance
their communication, information, and teamwork skills. At
NewYork-Presbyterian, the patient’s experience is everybody’s
responsibility from the housekeeper to the attending physician.”
“For example, when entering a patient’s room, we have a
step-by-step approach that all staff are expected to follow,”
notes Mr. Evans. “You knock, you introduce yourself, you tell
the patient and/or family members why you are there, then
you walk them through whatever you are doing. At the end of
the encounter you ask if there’s anything else you can do.
Make sure their needs are met right then and there. This is true
for everyone — clinical staff, residents, nurses, housekeepers.”
Many of these efforts focus on housestaff, who may not
be familiar or experienced with the nuances that make a
difference when interacting with patients. “We’ve actually
stopped residents and explained ‘the way we do this here is
we knock and we ask if we can enter the room.’ This may be
a new expectation for many of them; not all hospitals focus
on these behaviors,” says Ms. Mucaria. Housestaff are provided with training in these areas during their orientation.
The process includes role-playing exercises with residents in
various clinical situations, such as how do you give somebody difficult news, but also in customer service. “We are
fortunate to be partnering with Dr. Richard Liebowitz and
the Medical Staff Office to develop a program specifically
for the housestaff,’” adds Ms. Mucaria. “And an increasing
number of housestaff are involved in our patient satisfaction
initiatives throughout the Hospital.”
A Unique Approach to Advancing Patient Safety
NewYork-Presbyterian is recognized for its pioneering initiatives to ensure the highest quality and safety for the patient.
Among these efforts is the Hospital’s award-winning Patient
Safety Fridays program. Patient Safety Fridays was launched
in January 2008 after a thoughtful analysis of the existing
structure in operations, coordination, and communication to
determine the most effective and visible way to make an
impact. Each Friday morning, more than 600 clinical and nonclinical personnel across all Hospital sites convene for a onehour didactic session on clinical and environmental topics.
Following the didactic sessions, over 40 tracer teams visit all
clinical areas, enabling staff to quickly and efficiently identify
and correct gaps in safety and procedures. Data in 2009 has
shown that short- and long-term improvements are being
achieved regularly, including major improvements in hand
hygiene compliance, which increased from 70 percent to 96
percent; medication reconciliation compliance, which improved from 76 percent to 100 percent; and patient verification
compliance, which improved from 78 percent to 100 percent.
More importantly, Patient Safety Fridays is reinforcing the
Hospital-wide goal of becoming a high-reliability organization.
We Put Patients First Best Practices and Tools
Among the best practices for patient satisfaction being implemented across NewYork-Presbyterian with results that
are already outstanding are:
• A Service Recovery Program
• Post-Discharge Phone Calls
• Rewards and Recognition Programs
• Daily Huddles and Regular Staff Meetings
• Quiet Times and Healing Environments
• Hourly Rounding on Patients and Families
• Rounding for Recognition with Staff
Since the “We Put Patients First” effort was launched in 2006,
implementation of these best practices has helped NewYorkPresbyterian Hospital to significantly improve its satisfaction
scores. Future success depends on these and other practices
for patient satisfaction being observed with every patient,
every time. “It’s pretty simple,” notes Ms. Mucaria. “Imagine
every patient is one of your own family members and treat
them as you would your loved one!”
NEWS AND NOTES
1970s
Michael A. Bush, MD 1975 Medical Internship and Residency, Diabetes,
Endocrinology and Metabolism, Presbyterian Hospital “Going through
some papers from my daughter’s Columbia College graduation last
year, I spotted the listing of Award for Excellence in Teaching given to
Joseph Tenenbaum, Edgar Leifer Professor of Medicine — and my
mind cast back to 1972, when I first met Dr. Leifer. After medical school
at the University of Southern California, I was accepted for an externship at Columbia-Presbyterian and assigned to Edgar Leifer’s clinic.
“Tall, austere, always in a white coat, Dr. Leifer seemed to tower
above most of his associates, as much for the seriousness of his affect
as his actual height. He always seemed to lean forward in talking to
his patients, both to be at the same level and, perhaps, to be closer to
them and their troubles. Dr. Leifer was a staunch defender of the
general internist’s ability (and responsibility) to see through the
maze of conflicting expert consultations and make the final decision of what was right for his patient. This was, I still feel, a signature viewpoint of my training at Presbyterian Hospital.
“It would be a delight to him, I’m sure, that Joseph Tenenbaum
would receive a Presidential Award for Excellence in Teaching. As an
enthusiastic teacher myself of medical students, house officers, and
fellow physicians, I know that the secret joy of teaching is not just
what we give, but how much we ourselves learn in the process. I’m
sure Ed Leifer knew that as well. He gave to his trainees and to his
patients and, in turn, grew into the man we all admired.”
Kenneth L. Edelson, MD, FAACS 1978 Residency, Dermatology, New
York-Hospital-Cornell Medical Center Dr. Edelson was appointed to the
Department of Dermatology at Mount Sinai School of Medicine and
is an Attending Physician in the Department of Dermatology at The
Mount Sinai Hospital.
1980s
Howard J. Birenbaum, MD 1983 Residency, Pediatrics, and Fellowship,
Neonatal-Perinatal Medicine, New York Hospital-Cornell Medical Center
“Our youngest son, Daniel, was married over Memorial Day to
Michele Yuskovitz in Pittsburgh. Daughter, Lauren, lives in LA
with her husband and our grandson, Micah Liam. My son, Rob,
lives in Alexandria, VA, with his wife, Nira, and our grandchildren, Samantha and Zachary. I continue to reside in Owings
Mills, MD, with my wife, Debra, and direct a 30-bed tertiary level
(III-B) NICU at Greater Baltimore Medical Center.
Stephen S. Kamin, MD 1988 Residency, Internal Medicine, and
Fellowship, Neurology, New York Hospital-Cornell Medical Center
“I’m pleased to report that I am just finishing up a five-year stint
as Acting Chair of Neurology and Neurosciences at New Jersey
Medical School, Newark, New Jersey. I seem to have survived with
sanity more-or-less intact. The incoming chair is also a New York
Hospital grad — Ken Maiese, who finished his neurology residency
there in 1989.
NewYork-Presbyterian
Summer 2010
Vol. 3, No. 3
NewYork-Presbyterian Forum is published for former residents and
fellows of NewYork-Presbyterian Hospital/Columbia University Medical
Center and NewYork-Presbyterian Hospital/Weill Cornell Medical
Center. Please send your news to: Richard S. Liebowitz, MD, MHSc,
Vice President, Medical Affairs, [email protected]
1990s
Jonathan Mandell, MD 1992 Residency, General Surgery, New York
Hospital-Cornell Medical Center “I have been in private practice
with Andover Surgical Associates in Andover, MA since 1994. My
practice includes general and trauma surgery (local hospital level 3
trauma). My oldest daughter just graduated high school and my
youngest daughter will enter high school in the fall.
David M. Rube, MD 1993 Fellowship, Child and Adolescent Psychiatry,
NewYork-Presbyterian Hospital/Columbia University Medical Center/
Psychiatric Institute “I am the Clinical Director of Queens Children’s
Psychiatric Center and an Associate Clinical Professor of Psychiatry
at Columbia University. I recently completed a course of study
through the American College of Physician Executives and have been
awarded the title of CPE, Certified Physician Executive. I have also
been board certified in Forensic Psychiatry until 2020.”
Moneeka Zaman, MD, FAAP 1998 Residency, Pediatrics, New York
Hospital-Cornell Medical Center “I’m currently the Director of
Pediatric Continuity Clinics at the Maria Fareri Children’s Hospital
Residency Program, a partner at Children’s and Women’s Physicians
of Westchester, LLP, and an Assistant Professor of Pediatrics at
New York Medical College in Valhalla, NY. I also have an 11-yearold son and a 7-year old daughter and am loving life as a fulltime
pediatrician/mother.
2000s
Merle Myerson, MD 2001 Fellowship, Cardiology, NewYorkPresbyterian Hospital/Columbia University Medical Center Under the
direction of Dr. Myerson, the St. Luke’s-Roosevelt Hospital Cardiovascular Disease Prevention program is entering its fourth year.
The program incorporates a lipid clinic as well as comprehensive
cardiovascular risk factor diagnosis and management. New for
2010 is a Pre-Exercise Heart Screening Program for young athletes
who may have a congenital cardiac abnormality and older persons
who would like to start an exercise program but have risk factors
for cardiovascular disease.
Shahla Siddiqui, MD 2002 Fellowship, Critical Care in Anesthesia,
NewYork-Presbyterian Hospital “I am currently an Assistant Professor
at the Aga Khan University Hospital in Karachi, Pakistan. I have two
children. We love to travel, sail, ride horses, and eat great food!”
Sunil G. Bhandarkar, MD 2005 Residency, Ophthalmology, NewYorkPresbyterian Hospital/Weill Cornell Medical Center Dr. Bhandarkar
completed a LASIK and Cataract Fellowship with the Sinskey Eye
Institute in Santa Monica, California. He is pleased to announce the
opening of his practice specializing in cataract and LASIK surgery at
Saint John’s Health Center in Santa Monica.
IN MEMORIAM
Edgar Leifer, MD, PhD, a longtime devoted physician at NewYorkPresbyterian/Columbia University Medical Center and Professor
Emeritus of Clinical Medicine and special lecturer in the Department
of Medicine at Columbia University College of Physicians and
Surgeons passed away on July 2, 2010. Dr. Leifer was an expert in
radiochemistry and evolved into an iconic clinician and clinical
educator with a half-century of devoted service to his patients,
students, and the Hospital. On behalf of the members of NewYorkPresbyterian/Columbia Society of the Alumni we send sincere
condolences and sympathy to Dr. Leifer’s family.
Office of Medical Affairs
NewYork-Presbyterian Hospital
525 East 68th Street
New York, NY 10065
www.nyp.org/alumni
Top Ranked Hospital in New York.
Ten Years Running.
SIGN UP FOR CME
Continuing Medical Education (CME) activities are provided
through Columbia University College of Physicians and Surgeons:
www.cumc.columbia.edu/dept/cme or (212) 305-3334 and Weill
Cornell Medical College: www.med.cornell.edu/education/
programs/con_med_edu or (212) 746-2631. Both institutions are
accredited by the Accreditation Council for Continuing Medical
Education (ACCME) to authorize and issue CME credit. Visit
nyp.org/pro/events.html for all upcoming educational events
through NewYork-Presbyterian Hospital.
Frontiers in Diabetes Research - Cardiovascular Consequences of
Diabetes: The Role(s) of Inflammation
Date:
November 20, 2010
Location: NewYork-Presbyterian/Columbia
Russ Berrie Medical Science Pavilion
1150 St. Nicholas Avenue at West 168th Street
Second Annual New York Symposium on Parkinson’s Disease
Dates:
October 23, 2010
Location: Weill Cornell Medical College
Weill Auditorium, Second Floor, Room C-200
1300 York Avenue (at 69th Street), New York
For information/registration on these programs, visit:
www.nyp.org/pro or email [email protected]
SAVE THE DATE
NewYork-Presbyterian/Columbia Society of the
Alumni Annual Dinner • Tuesday, November 16, 2010
The annual dinner of the Society of the Alumni will honor two
distinguished Hospital alumni: Welton M. Gersony, MD,
Alexander S. Nadas Professor of Pediatrics, Pediatric Cardiology,
NewYork-Presbyterian/Morgan Stanley Children’s Hospital, and,
Mieczyslaw (Mike) Finster, MD, retired Attending Anesthesiologist, NewYork-Presbyterian/Columbia. The dinner will be held
at the Vivian and Seymour Milstein Family Heart Center’s
Riverview Terrace, located at 173 Fort Washington Avenue, NYC.
For ticket information, contact the Development Department at
(212) 342-0795.
IT’S ALL ABOUT ACCESS
The NewYork-Presbyterian Physician Access Transfer Center will
coordinate your patient’s transfer to the tertiary services available
at NewYork-Presbyterian Hospital.
One call 1-800-NYP-STAT
For a physician referral to any one of our 5,500 physicians across
all specialties, call the Referral Call Center at 1-877-NYP-WELL
PROFESSIONAL RESOURCES
NewYork-Presbyterian Alumni Website—nyp.org/alumni
The Alumni Association website is a valuable resource for the more
than 10,000 physicians who have trained at NewYork-Presbyterian.
Physician Career Initiative—nypsystem.org/physicians
The Physician Career Initiative alerts residents, fellows, and alumni
trained at NewYork-Presbyterian and NewYork-Presbyterian
Healthcare System hospitals to potential employment opportunities
within System-affiliated hospitals and regional physician practices.
To register, go to www.nypsystem.org/physicians. You will receive
e-mail announcements of available positions that match your
criteria and career requirements.
Educational Programs—nyp.org/pro
• Webcasts
• Medical Presentations
• CME Activities
• Newsletters
For more information about campus-specific Alumni Associations,
contact:
Tamiko B. Collier
NewYork-Presbyterian Hospital/
Columbia University
Medical Center
654 West 170th Street
New York, NY 10032
(212) 342-0954
[email protected]
Catherine E. Warner
NewYork Weill Cornell
Medical Center
Alumni Council (CAC)
525 East 68th Street
Box 123
New York, NY 10065
(212) 821-0948
[email protected]
www.med.cornell.edu/about/cac